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Cavus Foot

Cavus foot is a high arched foot, generally speaking, they can usually be managed with bracing, some need surgery, but the important thing here is that particularly unilateral cavus foot or a cavus foot that seems to be progressive is often a marker for a neurologic disorder such as Freidrich’s ataxia or a spinal cord tumor.

So you have to do a careful neurologic exam and send the child on to a neurologist if you have any suspicions about this. Calcaneal valgus foot, mentioned it briefly, it’s usually a packaging defect that resolves, there is a differential here, it can be congenital vertical talus, or rockerbottom foot where the talus.

This can’t be stretched out, this needs surgery, so if you have a child who can’t plantar flex and who is very flatfooted, send him on so we can figure out if this is that they have.

Club foot as I mentioned before, it has components, metatarsus adductus which you know about, equina which is plantar flexion, you can’t dorsiflex their ankle and varus which is supination or inversion, turning in of the foot. This is pretty common, one in a thousand live births, 20% of these children will have development dysplasia of the hip. This is a real association, so you have to be very careful and really examine children with clubfeet very carefully for DDH. If this is unilateral, bilateral half the time, but if it’s unilateral the affected foot and calf will always be smaller. That’s because this is probably not a packaging defect, this is probably either a germ plasm defect, neurovascular insult.

No one is really sure exactly what, but it’s not a packaging thing, and these feet and muscles never quite catch up to the other side. It does run in families but it doesn’t have an inheritance pattern. Treatment wise, about 25% of these can be corrected with stretch casting alone where you cast the feet every two weeks for several months and gradually correct the deformities out. It’s not an easy thing to do, there’s an art to it and practitioners are different in how much success they have with that, but overall, 75% of these children come to surgery, the surgery is complicated and you basically have to release everything that’s not in the right position or tight, and gradually get the foot into a flat corrected position. After treatment, these children have very good function in their feet and it’s essentially normal usually. This is actually a child with a clubfoot, this child has already had surgery and actually needed subsequent surgery, this is the original surgical scar, it’s not common, but some kids do need a second surgery for this.

Flatfoot though which is flexible, meaning that when you stand the child on their toes, they get their arch back, and their foot can plantar flex and dorsiflex easily, this is usually not of any long term import, they used to give these kids orthotics, they don’t do anything in the long term, this is another one of those things that goes along with ligaments laxity and is a variant of normal. Usually we don’t do much treatment for this. If it’s rigid, meaning you can’t form an arch in the ankle and subtalar joint, don’t move well, and the foot is becoming painful, get an x-ray and look for a tarsal coalition which is a fusion between some of the tarsal bones in the foot. Those need to be referred if they are painful, they need to be surgically excised.